Healthcare Provider Details

I. General information

NPI: 1659453132
Provider Name (Legal Business Name): CATHERINE SETKOWSKY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 FARBER DR UNIT D
BELLPORT NY
11713-1500
US

IV. Provider business mailing address

11 FARBER DR UNIT D
BELLPORT NY
11713-1500
US

V. Phone/Fax

Practice location:
  • Phone: 631-286-0700
  • Fax: 631-286-0688
Mailing address:
  • Phone: 631-286-0700
  • Fax: 631-286-0688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number232827-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: